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Obamacare offers health insurance, not health care

Thursday, March 20, 2014By: RJC Executive Director Matt Brooks

In March, the Obama administration reported on Obamacare’s enrollment numbers. Fewer people have signed up than the administration had hoped, especially among the young and healthy. For many people, even the previously uninsured, the choices in the Obamacare market are simply not what they’re looking for in a health insurance plan.

It’s easy to understand why.

Obamacare replaces a wide variety of market-determined plans with a limited number of plans containing narrow networks of doctors and hospitals and a required set of items covered. No more cheap catastrophic care plan for the young man in his first job. Families and businesses can’t choose an insurance plan that meets their circumstances and needs. Now the government sets the plans and the networks.

The result is that cancer patients are losing access to the doctors and hospitals they rely on. Parents are losing their trusted pediatricians. And families may not have access to the hospital nearest to their homes.

Consider this: In Georgia, one of the five insurers offering plans on the Obamacare exchanges has just one hospital in the entire state in its network. In California and New York, major plans exclude the world-class Cedars-Sinai Hospital in Los Angeles and New York City’s Memorial Sloan-Kettering.

For those with serious and chronic illnesses, there is more terrible news. Many people are finding that their expensive, life-saving medications are not covered under their new Obamacare plans.

Some families do pay less for their monthly premiums for Obamacare-subsidized plans. Many more working families, who earn too much to qualify for subsidized plans, are paying considerably more each month for their health insurance. But the monthly premium is not the only cost in a health insurance plan.

Families are finding that their insurance won’t begin paying for care until they’ve spent $5,000, $10,000, or more of their own money toward the deductible first. And once the deductible is met, the co-insurance (the amount the plan pays) may be as low as 60 percent, leaving individuals to pay the rest of the bill for their care by themselves.

Most plans in the previous insurance market had an “out-of-pocket” cap to prevent people from losing everything in the event of a serious health problem. But in the Obamacare exchanges, some plans are offered with out-of-pocket protection only for care provided in-network. If you go to a doctor or hospital outside of your network, your insurance plan may pay nothing.

People who rely on an expensive medication—for multiple sclerosis, severe rheumatoid arthritis, or HIV for example—are seeing their medication costs skyrocket. If the medication is covered by their insurance plan, they may still have to pay 40 percent of the cost, or thousands of dollars a year, up to the out-of-pocket limit. If the medication is not covered, they must pay the full price and the cost does not count toward the deductible or out-of-pocket maximum. Their expenses then are literally limitless.

One of the most serious problems with Obamacare is that it mistakes health insurance for health care. Obamacare supporters pretend that if every person has a health insurance plan, then they are getting the health care they need. That is simply not true. As we have seen, a plan that doesn’t include your doctor or your medication doesn’t provide the care you need. But there is another serious problem quickly coming into view.

For decades, poor people in this country have been eligible for Medicaid. The amount the government pays doctors to see Medicaid patients, however, is very low. At some point, when a doctor is not getting paid enough to cover the basic expenses of providing care, he or she will stop accepting Medicaid patients, or get out of medicine altogether. That is why today Medicaid patients can wait months for care, if they can find a doctor who will see them at all.

Obamacare specifically expands Medicaid to a wider segment of the population. Young adults with low incomes and the children of low-income families may have Medicaid as their only choice in the Obamacare exchanges, based on family income. So far, enrollment in Medicaid has been more than half of the signups made under the new Obamacare rules. Who will provide care to those people? How long will they have to wait to see a doctor?

In 2008, about 15 percent of Americans were uninsured. The Congressional Budget office projects that under Obamacare, in the years 2013-2023, the percentage of uninsured will never fall below 11 percent of the population. That’s not much of a change in health insurance rates, at the expense of more expensive, less accessible health care for millions more Americans.